Neurocognitive Disorder due to Alzheimer’s Disease Case Study

Which is the best response by the nurse to Mr. Caudill’s statement?
A. “Mr. Caudill, there is nothing to worry about.”
B. “Anxiety is common when people have problems remembering things. You will be fine.”
C. “You look worried. How can I make you feel more comfortable?”
D. “You have Alzheimer’s disease and have become more forgetful lately.”
C. “You look worried. How can I make you feel more comfortable?”

This response acknowledges the clients feelings and the word “worried” is generally neutral.

Which of the following are risk factors for Alzheimer’s disease? (Select all that apply.)
A. Advancing age.
B. Increased serum calcium.
C. Use of aluminum products.
D. Father and uncle had Alzheimer’s disease.
E. Previous head trauma.
A. Advancing age.
D. Father and uncle had Alzheimer’s disease.
E. Previous head trauma.

The risk for developing Alzheimer’s disease increases as age advances. A family history is a known risk factor for Alzheimer’s disease. There is an association between a history of head trauma and Alzheimer’s disease, particularly repeated head trauma.

What is the best initial response by the nurse?
A. “Changes in behavior and personality often occur as Alzheimer’s disease progresses.”
B. “Behavior changes may indicate that he has already progressed to a later stage of the disease.”
C. “Behavior changes are probably the result of his effort to cope with his altered mental function.”
D. “Behavior changes usually indicate that the person is feeling depressed about the situation.”
A. “Changes in behavior and personality often occur as Alzheimer’s disease progresses.”

Subtle changes in behavior and personality, which would easily be recognized by a loved one, occur even in early AD.

Which question gives the nurse the most information about Mr. Caudill’s judgment?
A. “Are you in good spirits most of the time?”
B. “If you smelled smoke in a movie theater, what would you do?”
C. “Who is the current President of the United States?”
D. “What was the name of your favorite childhood pet?”
B. “If you smelled smoke in a movie theater, what would you do?”

This question elicits the most information about judgment. The client must know what a fire is and describe how he would react.

What is the best response to Mr. Caudill by the nurse?
A. “Hang in there. I will be done shortly.”
B. “Let’s take a break. Would you like a cup of water?”
C. “I appreciate your cooperation. Tell me what you think is the problem.”
D. “Your daughter is worried about you.”
C. “I appreciate your cooperation. Tell me what you think is the problem.”

This acknowledges the client’s concerns and engages him in his own care as much as possible. Giving the client some control may decrease his anxiety.

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Which of the following memory issues/deficits are related to Mild Neurocognitive disorder due to Alzheimer’s disease? (Select all that apply.)
A. Temporarily misplaces keys and purse.
B. Forgets the purpose or use of an item.
C. Cooks a meal and forgets to serve it.
D. Momentarily forgets an acquaintance’s name.
E. Becomes lost on the client’s own street.
B. Forgets the purpose or use of an item.
C. Cooks a meal and forgets to serve it.
E. Becomes lost on the client’s own street.

This type of memory loss is associated with Alzheimer’s disease.

What is the best response?
A. “Your father is in the middle stage of this disease and he will stabilize at this level of functioning for some time.”
B. “Everyone responds differently to this disease, but it is likely that his health and daily functioning will continue to decline.”
C. “I know you are worried about him, but there is nothing that you can do.”
D. “Do you have a friend or a family member who can help you?”
B. “Everyone responds differently to this disease, but it is likely that his health and daily functioning will continue to decline.”

This is the most accurate description of this disease, and it allows the client’s daughter to participate in her father’s plan of care.

What is the goal of nursing care for a client with a neurocognitive disorder due to Alzheimer’s disease?
A. Individualizing care.
B. Improving cognition.
C. Maintaining optimum function.
D. Promoting self-confidence and self-esteem.
C. Maintaining optimum function.

There is not a cure for Alzheimer’s disease, but support can help the client and the client’s family live at a maximum level.

What does the nurse suspect that Mr. Caudill is experiencing?
A. Delirium.
B. Dementia.
C. Schizophrenia.
D. Delirium tremens.
A. Delirium

Recent onset along with visual hallucinations indicates a possible delirium.

What should the nurse advise the client’s daughter to do? (Select all that apply.)
A. Ignore the behavior.
B. Tell her father that the man is a friend.
C. Make sure her father’s room has sufficient light.
D. Tell her father that he does not see anyone and that it is in his imagination.
E. Divert her father’s attention with food or drink.
C. Make sure her father’s room has sufficient light.
E. Divert her father’s attention with food or drink.

Shadows can increase confusion and support delusions. Night time confusion can be reduced by diverting the client to something familiar and soothing.

How does Donepezil (Aricept) reduce the symptoms for clients with mild to moderate Alzheimer’s disease?
A. Enhancing Acetylcholine function.
B. Inhibiting Serotonin Uptake.
C. Anti-oxidating free radical.
D. Reducing GABA action.
A. Enhancing Acetylcholine function.

Donepezil (Aricept) prevents an enzyme known as acetylcholinesterase from breaking down acetylcholine in the brain. Increased concentrations of acetylcholine lead to increased communication between the nerve cells that use acetylcholine as a chemical messenger, which may temporarily improve or stabilize the symptoms of Alzheimer’s disease.

What side effect of donepezil (Aricept) is most important for Mr. Caudill’s taught to report to the HCP?
A. Tarry stool.
B. Fatigue.
C. Loss of appetite.
D. Insomnia.
A. Tarry stool.

A bloody, black, or tarry stool may indicate GI bleeding, a serious side effect of the medication.

Which lab test should be scheduled?
A. Serum BUN and creatinine.
B. Serum liver enzymes.
C. Urinalysis.
D. Which blood count.
B. Serum liver enzymes.

Liver toxicity is a significant side effect of acetylcholinesterase inhibitors, so liver function tests should be monitored regularly.

What is the goal for the care of a client with mild-to-moderate Alzheimer’s disease who takes donepezil (Aricept)?
A. The client will maintain the highest level of cognitive ability.
B. The client will demonstrate improved cognitive ability within one month.
C. The client will engage in abstract thinking within one month.
D. The client will communicate clearly within one month.
A. The client will maintain the highest level of cognitive ability.

Donepezil (Aricept) slows cell destruction.

Which finding is most concerning to the PN?
A. Mr. Caudill sloshes his milk from the side of his glass when he sets it down.
B. Mr. Caudill watches his daughter eat and mimics her as she takes a bite.
C. Mr. Caudill reaches for the plastic fruit used in the table’s centerpiece.
D. Mr. Caudill’s eyes water each time he swallows a bite of meat or bread.
D. Mr. Caudill’s eyes water each time he swallows a bite of meat or bread.

Watering eyes during swallowing could indicate silent aspiration or choking, and it requires immediate medical evaluation. During the late stages of Alzheimer’s disease, individuals can lose the mechanical ability to swallow, and they are at increased risk for aspiration.

Which information would support this?
A. Mr. Caudill sleeps through the night.
B. Mr. Caudill is able to control his bladder at times.
C. Mr. Caudill often wanders around the house.
D. Mr. Caudill denies feeling any pain.
A. Mr. Caudill sleeps through the night.

Trazodone (Desyrel) is an antidepressant often used to improve sleep in the client with AD.

Which finding is most important for the PN to report to the Home Health RN?
A. Mr.s Caudill’s dry and flaky skin.
B. It takes Mr. Caudill longer to finish a meal.
C. Mr. Caudill has a weak and thready pulse.
D. Mr. Caudill rejects foods that he previously liked.
C. Mr. Caudill has a weak and thready pulse.

A weak and thready pulse may indicate severe vascular dehydration and should be reported immediately.

Which are the common components of an advance directive for healthcare? (Select all that apply.)
A. Appointment of another person to make healthcare decisions if the client is unable.
B. Specific or general instructions about physical healthcare treatment.
C. The naming of individuals to whom personal possessions will be given in the event of a death.
D. Specific or general instructions about mental or psychological healthcare treatment.
E. A section explaining the document is legal and cannot be changed by the client once signed.
A. Appointment of another person to make healthcare decisions if the client is unable.
B. Specific or general instructions about physical healthcare treatment.
D. Specific or general instructions about mental or psychological healthcare treatment.

Also known as a durable power of attorney, this can be a part of an advance directive for healthcare. It names another person to make healthcare decisions if the individual is mentally or physically unable. Decisions or preferences about physical, mental, or psychological healthcare treatment such as the use or nonuse of a ventilator can be outlined in an advance directive for healthcare or electrical shock treatment can be outlined in an advance directive for healthcare.

Which response by the RN is most therapeutic?
A. “This may be traumatic so it is best if you wait outside the room please.”
B. “I will pull up a chair so that you may sit on the left side of the bed and hold his hand.”
C. “Let’s ask your father is he wants you to stay in the room for the procedure.”
D. “Clients generally follow staff requests if family members are not present.”
B. “I will pull up a chair so that you may sit on the left side of the bed and hold his hand.”

Mr. Caudill’s daughter’s presence may make the procedure safer and less traumatic.

What is the best response by the nurse?
A. “You must correct his inaccurate statements to promote reality orientation.”
B. “You are right to balance his feelings with the need to promote reality.”
C. “He is attempting to manipulate you and make sure he gets his own way.”
D. “There is no reason to attempt to correct your father because he will not understand.”
B. “You are right to balance his feelings with the need to promote reality.”

Reality orientation is an important tool for the client with AD, but, as the disease progresses, it often causes the client to become agitated. It is important to recognize the feelings and emotions of the client with AD.

Which action should the RN take?
A. Encourage increased physical activity 1 hour before bedtime.
B. Keep the room well lit during the evening hours.
C. Provide a mild stimulant such as coffee during the day to reduce afternoon napping.
D. Contact the HCP and request a sedative for nighttime use to promote sleep.
B. Keep the room well lit during the evening hours.

Adequate lighting can decrease agitation that occurs when surroundings are unfamiliar or dark. Reduced lighting and increased shadows can cause the client with Alzheimer’s disease to misinterpret what they see.

What action should the nurse implement first?
A. Redirect Mr. Caudill’s attention to a familiar object from his home.
B. Quietly leave the room until he calms down.
C. Assign an unlicensed assistive personnel (UAP) to remain with the client.
D. Apply a soft vest restraint and bed alarm.
A. Redirect Mr. Caudill’s attention to a familiar object from his home.

The nurse should first attempt to calm the client by redirecting his attention or distracting him from the source of the anxiety.

What initial action should the nurse take?
A. Evaluate Mr. Caudill’s vital signs before transferring him to his bed.
B. Monitor Mr. Caudill’s blood glucose level after he is back in his bed.
C. Assist wth transferring Mr. Caudill to his bed and turn on a night light.
D. Advise the UAP to turn off the room light and let Mr. Caudill rest in the chair.
A. Evaluate Mr. Caudill’s vital signs before transferring him to his bed.

Mr. Caudill may be experiencing an adverse effect of the medication, and he should be assessed before further action is initiated.

After assisting Mr. Caudill to the bed, which nursing action has the highest priority?
A. Administer oxygen per nasal cannula.
B. Notify the HCP of the vital signs.
C. Provide several warm blankets.
D. Elevate Mr. Caudill’s feet fifteen degrees.
D. Elevate Mr. Caudill’s feet fifteen degrees.

Mr. Caudill is experiencing hypotension secondary to his initial dose of the antipsychotic medication. The priority nursing action is to restore his blood pressure.

Which behavior(s) are commonly associated with caregiver role strain? (Select all that apply.)
A. Reports of physical symptoms such as frequent headaches.
B. Feels a sadness that will not go away.
C. Allows other family members to provide care one day per week.
D. Frequently forgets to change care recipient’s soiled linens.
E. Withdraws from family and friends.
A. Reports of physical symptoms such as frequent headaches.
B. Feels a sadness that will not go away.
D. Frequently forgets to change care recipient’s soiled linens.
E. Withdraws from family and friends.

Reports of frequent physical symptoms are a sign of caregiver stress. Mental health issues, including depression, are prevalent among caregivers of clients with chronic illnesses such as Alzheimer’s disease. Abuse or neglect is sometimes associated with increased caregiver stress or burden. Caregivers who are experiencing stress often withdraw from family, friends, and social activities.

Which question is most important to ask Mr. Caudill’s daughter before developing the plan of care to address caregiver role strain?
A. “How is your family coping with your father’s illness?”
B. “What do you find most stressful in your daily life?”
C. “Do you attend a caregiver support group?”
D. “How much time do you spend taking care of yourself?”
B. “What do you find most stressful in your daily life?”

This question will focus the caregiver on the daughter’s needs.

What is the best response by the nurse?
A. “I would feel guilty for thinking that, too.”
B. “Why do you feel he would be better off?”
C. “You are probably just too tired to think clearly.”
D. “You have many conflicting emotions right now.”
D. “You have many conflicting emotions right now.”

This response restates the daughter’s feelings and provides the opportunity for her to continue to share concerns.

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